randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis

purpose: to compare the efficacy of intravitreal clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. methods: in this prospective, randomized single-masked clinical trial a total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone (ivcd) group and 34 in the classic treatment (ct) group. the ivcd group received 1 to 3 injection(s) of 1 mg intravitreal clindamycin and 400 mg dexamethasone, and the ct group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. antitoxoplasmosis antibodies (immunoglobulin [ig] m and igg) were measured using an enzyme-linked immunosorbent assay. results: the mean number of injections in the ivcd group was 1.6. lesion size reduction was statistically significant after treatment in both ivcd and ct groups (p< 0.001 and p: 0.009, respectiveiy). the difference in mean percentage of reduction at 6 weeks was not significant: 57±27.6% in the ivcd group versus 58.4±29.3% in the ct group. in comparison to baseline, va increased by 0.44±0.24 and 0.29±0.19 logarithm of the minimum angle of resolution units in the ivcd and ct groups, respectively (p< 0.001); however, the difference in va improvement between the groups was not significant. the interaction effect of igm and treatment group on lesion size reduction was significant (p= 0.002); this indicated that igm-positive cases responded better to ct and igm-negative cases responded better to ivcd treatment. vitreous inflammation reduction was comparable between the groups. within 2 years, 4 eyes (2 in each group) had 1 episode of recurrence. adverse drug reactions occurred in 2 patients in the ct group. no major injection-related complication was encountered in the ivcd group. conclusion: intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to classic treatment in ocular toxoplasmosis. it may offer more convenience, a safer systemic profile, greater availability, and fewer follow-up visits and hematologic evaluations.